Risk of diabetes after para-aortic radiation for testicular cancer

Harmke J. Groot; Jourik A. Gietema; Berthe M. P. Aleman; Luca Incrocci; Ronald de Wit; J. Alfred Witjes; Gerard Groenewegen; Peter de Brouwer; Otto W. M. Meijer; Maarten C. C. M. Hulshof; Hetty A. van den Berg; Tineke J. Smilde; Ben G. L. Vanneste; Maureen J. Aarts; Alphonsus C. M. van den Bergh; J. Martijn Kerst; Alexandra W. van den Belt-Dusebout; Sjoukje Lubberts; Katarzina Jozwiak; Simon Horenblas; Flora E. van Leeuwen; Michael Schaapveld

doi:10.1038/s41416-018-0248-x

Risk of diabetes after para-aortic radiation for testicular cancer

Harmke J. Groot, Jourik A. Gietema, Berthe M. P. Aleman, Luca Incrocci, Ronald de Wit, J. Alfred Witjes, Gerard Groenewegen, Peter de Brouwer, Otto W. M. Meijer, Maarten C. C. M. Hulshof, Hetty A. van den Berg, Tineke J. Smilde, Ben G. L. Vanneste, Maureen J. Aarts, Alphonsus C. M. van den Bergh, J. Martijn Kerst, Alexandra W. van den Belt-Dusebout, Sjoukje Lubberts, Katarzina Jozwiak, Simon HorenblasFlora E. van Leeuwen, Michael Schaapveld^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

11 Citations (Web of Science)

Abstract

BACKGROUND: While the risk of diabetes is increased following radiation exposure to the pancreas among childhood cancer survivors, its association among testicular cancer (TC) survivors has not been investigated.

METHODS: Diabetes risk was studied in 2998 1-year TC survivors treated before 50 years of age with orchidectomy with/without radiotherapy between 1976 and 2007. Diabetes incidence was compared with general population rates. Treatment-specific risk of diabetes was assessed using a case-cohort design.

RESULTS: With a median follow-up of 13.4 years, 161 TC survivors were diagnosed with diabetes. Diabetes risk was not increased compared to general population rates (standardised incidence ratios (SIR): 0.9; 95% confidence interval (95% CI): 0.7-1.1). Adjusted for age, para-aortic radiotherapy was associated with a 1.66-fold (95% CI: 1.05-2.62) increased diabetes risk compared to no radiotherapy. The excess hazard increased with 0.31 with every 10 Gy increase in the prescribed radiation dose (95% CI: 0.11-0.51, P = 0.003, adjusted for age and BMI); restricted to irradiated patients the excess hazard increased with 0.33 (95% CI:-0.14 to 0.81, P = 0.169) with every 10 Gy increase in radiation dose.

CONCLUSION: Compared to surgery only, para-aortic irradiation is associated with increased diabetes risk among TC survivors.

Original language	English
Pages (from-to)	901-907
Number of pages	7
Journal	British Journal of Cancer
Volume	119
Issue number	7
DOIs	https://doi.org/10.1038/s41416-018-0248-x
Publication status	Published - 2 Oct 2018

Keywords

STAGE-I SEMINOMA
LONG-TERM SURVIVORS
GERM-CELL CANCER
FOLLOW-UP
CARDIOVASCULAR-DISEASE
A-REPORT
MELLITUS
SURVEILLANCE
RADIOTHERAPY
CARBOPLATIN

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Cite this

Groot, H. J., Gietema, J. A., Aleman, B. M. P., Incrocci, L., de Wit, R., Witjes, J. A., Groenewegen, G., de Brouwer, P., Meijer, O. W. M., Hulshof, M. C. C. M., van den Berg, H. A., Smilde, T. J., Vanneste, B. G. L., Aarts, M. J., van den Bergh, A. C. M., Kerst, J. M., van den Belt-Dusebout, A. W., Lubberts, S., Jozwiak, K., ... Schaapveld, M. (2018). Risk of diabetes after para-aortic radiation for testicular cancer. British Journal of Cancer, 119(7), 901-907. https://doi.org/10.1038/s41416-018-0248-x

@article{33db01a2fd5b4dbbabd256eebf5e21a4,

title = "Risk of diabetes after para-aortic radiation for testicular cancer",

abstract = "BACKGROUND: While the risk of diabetes is increased following radiation exposure to the pancreas among childhood cancer survivors, its association among testicular cancer (TC) survivors has not been investigated.METHODS: Diabetes risk was studied in 2998 1-year TC survivors treated before 50 years of age with orchidectomy with/without radiotherapy between 1976 and 2007. Diabetes incidence was compared with general population rates. Treatment-specific risk of diabetes was assessed using a case-cohort design.RESULTS: With a median follow-up of 13.4 years, 161 TC survivors were diagnosed with diabetes. Diabetes risk was not increased compared to general population rates (standardised incidence ratios (SIR): 0.9; 95% confidence interval (95% CI): 0.7-1.1). Adjusted for age, para-aortic radiotherapy was associated with a 1.66-fold (95% CI: 1.05-2.62) increased diabetes risk compared to no radiotherapy. The excess hazard increased with 0.31 with every 10 Gy increase in the prescribed radiation dose (95% CI: 0.11-0.51, P = 0.003, adjusted for age and BMI); restricted to irradiated patients the excess hazard increased with 0.33 (95% CI:-0.14 to 0.81, P = 0.169) with every 10 Gy increase in radiation dose.CONCLUSION: Compared to surgery only, para-aortic irradiation is associated with increased diabetes risk among TC survivors.",

keywords = "STAGE-I SEMINOMA, LONG-TERM SURVIVORS, GERM-CELL CANCER, FOLLOW-UP, CARDIOVASCULAR-DISEASE, A-REPORT, MELLITUS, SURVEILLANCE, RADIOTHERAPY, CARBOPLATIN",

author = "Groot, {Harmke J.} and Gietema, {Jourik A.} and Aleman, {Berthe M. P.} and Luca Incrocci and {de Wit}, Ronald and Witjes, {J. Alfred} and Gerard Groenewegen and {de Brouwer}, Peter and Meijer, {Otto W. M.} and Hulshof, {Maarten C. C. M.} and {van den Berg}, {Hetty A.} and Smilde, {Tineke J.} and Vanneste, {Ben G. L.} and Aarts, {Maureen J.} and {van den Bergh}, {Alphonsus C. M.} and Kerst, {J. Martijn} and {van den Belt-Dusebout}, {Alexandra W.} and Sjoukje Lubberts and Katarzina Jozwiak and Simon Horenblas and {van Leeuwen}, {Flora E.} and Michael Schaapveld",

year = "2018",

month = oct,

day = "2",

doi = "10.1038/s41416-018-0248-x",

language = "English",

volume = "119",

pages = "901--907",

journal = "British Journal of Cancer",

issn = "0007-0920",

publisher = "Nature Publishing Group",

number = "7",

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Groot, HJ, Gietema, JA, Aleman, BMP, Incrocci, L, de Wit, R, Witjes, JA, Groenewegen, G, de Brouwer, P, Meijer, OWM, Hulshof, MCCM, van den Berg, HA, Smilde, TJ, Vanneste, BGL , Aarts, MJ, van den Bergh, ACM, Kerst, JM, van den Belt-Dusebout, AW, Lubberts, S, Jozwiak, K, Horenblas, S, van Leeuwen, FE & Schaapveld, M 2018, 'Risk of diabetes after para-aortic radiation for testicular cancer', British Journal of Cancer, vol. 119, no. 7, pp. 901-907. https://doi.org/10.1038/s41416-018-0248-x

TY - JOUR

T1 - Risk of diabetes after para-aortic radiation for testicular cancer

AU - Groot, Harmke J.

AU - Gietema, Jourik A.

AU - Aleman, Berthe M. P.

AU - Incrocci, Luca

AU - de Wit, Ronald

AU - Witjes, J. Alfred

AU - Groenewegen, Gerard

AU - de Brouwer, Peter

AU - Meijer, Otto W. M.

AU - Hulshof, Maarten C. C. M.

AU - van den Berg, Hetty A.

AU - Smilde, Tineke J.

AU - Vanneste, Ben G. L.

AU - Aarts, Maureen J.

AU - van den Bergh, Alphonsus C. M.

AU - Kerst, J. Martijn

AU - van den Belt-Dusebout, Alexandra W.

AU - Lubberts, Sjoukje

AU - Jozwiak, Katarzina

AU - Horenblas, Simon

AU - van Leeuwen, Flora E.

AU - Schaapveld, Michael

PY - 2018/10/2

Y1 - 2018/10/2

N2 - BACKGROUND: While the risk of diabetes is increased following radiation exposure to the pancreas among childhood cancer survivors, its association among testicular cancer (TC) survivors has not been investigated.METHODS: Diabetes risk was studied in 2998 1-year TC survivors treated before 50 years of age with orchidectomy with/without radiotherapy between 1976 and 2007. Diabetes incidence was compared with general population rates. Treatment-specific risk of diabetes was assessed using a case-cohort design.RESULTS: With a median follow-up of 13.4 years, 161 TC survivors were diagnosed with diabetes. Diabetes risk was not increased compared to general population rates (standardised incidence ratios (SIR): 0.9; 95% confidence interval (95% CI): 0.7-1.1). Adjusted for age, para-aortic radiotherapy was associated with a 1.66-fold (95% CI: 1.05-2.62) increased diabetes risk compared to no radiotherapy. The excess hazard increased with 0.31 with every 10 Gy increase in the prescribed radiation dose (95% CI: 0.11-0.51, P = 0.003, adjusted for age and BMI); restricted to irradiated patients the excess hazard increased with 0.33 (95% CI:-0.14 to 0.81, P = 0.169) with every 10 Gy increase in radiation dose.CONCLUSION: Compared to surgery only, para-aortic irradiation is associated with increased diabetes risk among TC survivors.

AB - BACKGROUND: While the risk of diabetes is increased following radiation exposure to the pancreas among childhood cancer survivors, its association among testicular cancer (TC) survivors has not been investigated.METHODS: Diabetes risk was studied in 2998 1-year TC survivors treated before 50 years of age with orchidectomy with/without radiotherapy between 1976 and 2007. Diabetes incidence was compared with general population rates. Treatment-specific risk of diabetes was assessed using a case-cohort design.RESULTS: With a median follow-up of 13.4 years, 161 TC survivors were diagnosed with diabetes. Diabetes risk was not increased compared to general population rates (standardised incidence ratios (SIR): 0.9; 95% confidence interval (95% CI): 0.7-1.1). Adjusted for age, para-aortic radiotherapy was associated with a 1.66-fold (95% CI: 1.05-2.62) increased diabetes risk compared to no radiotherapy. The excess hazard increased with 0.31 with every 10 Gy increase in the prescribed radiation dose (95% CI: 0.11-0.51, P = 0.003, adjusted for age and BMI); restricted to irradiated patients the excess hazard increased with 0.33 (95% CI:-0.14 to 0.81, P = 0.169) with every 10 Gy increase in radiation dose.CONCLUSION: Compared to surgery only, para-aortic irradiation is associated with increased diabetes risk among TC survivors.

KW - STAGE-I SEMINOMA

KW - LONG-TERM SURVIVORS

KW - GERM-CELL CANCER

KW - FOLLOW-UP

KW - CARDIOVASCULAR-DISEASE

KW - A-REPORT

KW - MELLITUS

KW - SURVEILLANCE

KW - RADIOTHERAPY

KW - CARBOPLATIN

U2 - 10.1038/s41416-018-0248-x

DO - 10.1038/s41416-018-0248-x

M3 - Article

VL - 119

SP - 901

EP - 907

JO - British Journal of Cancer

JF - British Journal of Cancer

SN - 0007-0920

IS - 7

ER -